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The prevalence of food allergies has doubled in the past 10 years. Peanut allergies are a significant public health issue and are the primary reason for food-related anaphylactic reactions that result in death. Evidence supports that early introduction of the peanut protein (or in combination with immunotherapy) to the highly allergic may safely desensitize patients, which could lead to less adverse allergic reactions and alter allergy management overall. [ABSTRACT FROM AUTHOR]

Background Estimates of the prevalence of allergic rhinitis in the United States range from 20% to 40%. Allergen-specific immunotherapy (SIT) is typically recommended for patients with allergic rhinitis who fail medical treatment, desire an alternative to pharmacotherapy, or would like to pursue therapy that can potentially change the natural history of the disease. Sublingual immunotherapy (SLIT) involves dosing the allergen under the tongue of the sensitized individual in controlled amounts, frequently, over a period of several years, in order to increase immunologic tolerance and diminish symptoms to that allergen. The U.S. Food and Drug Administration (FDA) approved the use of SLIT tablets in 2014, whereas the use of aqueous SLIT by U.S. practitioners is considered an 'off-label' use. Methods This study is a review of published English language scientific literature, focusing on systematic reviews and randomized controlled trials of SLIT for inhalant allergic rhinitis. Results SLIT is a safe and effective immune modulating treatment that decreases symptoms and medication use for allergic rhinitis. Further study is needed to determine the relative effectiveness of SLIT compared to subcutaneous immunotherapy, the role of multiple-allergen vs single-allergen SLIT, the use of SLIT in special populations (pregnancy, patients taking beta-blockers), and optimal dosing of U.S. products. Conclusion SLIT is safe and effective, and offers a convenient alternative to injection immunotherapy for appropriate patients with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Specific allergen immunotherapy has been practiced for allergic rhinoconjunctivitis for over 100 years and is the only treatment option that is disease modifying. In the USA, immunotherapy is usually administered via subcutaneous injection; this is the only route with a US FDA-approved formulation. There is growing interest in developing US-standardized formulations for the sublingual route, but up until recently there have been few US trials. Most of the experience with sublingual immunotherapy (SLIT) comes from Europe, where it is widely used and there is a large body of literature supporting its use. The purpose of this review is to summarize recent adult and pediatric clinical trials of SLIT in the USA. Most of the trials are for inhalant allergies, but there is some early work on SLIT as a novel therapy for food allergies. INSET: Key issues. [ABSTRACT FROM AUTHOR]

Background: Increasing interest in sublingual immunotherapy (SLIT) among practitioners and patients has resulted in numerous publications and clinical trials in recent years. With the clinical growth of SLIT, discussions of its efficacy, safety, and immunologic effects have intensified, as have comparisons to subcutaneous immunotherapy (SCIT). In the United States, SCIT has been the traditional form of immunotherapy for inhalant allergy and is the only immunotherapy method approved by the U.S. Food and Drug Administration at this time. The similarities and differences between SLIT and SCIT are often discussed, yet clinical studies directly comparing these immunotherapy methods are scarce. Methods: A literature review of specific issues and controversies between SLIT and SCIT for allergic rhinitis was conducted. Results: Safety, efficacy, and immunologic effects of these two immunotherapy techniques are reviewed. Conclusion: Unanswered questions relating to SLIT are examined. [ABSTRACT FROM AUTHOR]

Background: Few trials of sublingual immunotherapy (SLIT) in the United States have been reported. Objective: This randomized, placebo-controlled feasibility SLIT study compared the safety and physiologic effects of high- versus low-dose Dermatophagoides farinae vaccine. Methods: Thirty-one D farinae–sensitive adults with allergic rhinitis with or without mild intermittent asthma were eligible for randomization to high-dose maintenance vaccine (n = 10, 4200 allergen units [approximately 70 μg of Der f 1/d]), low-dose maintenance vaccine (n = 10; 60 allergen units [approximately 1 μg of Der f 1/d]), or placebo (n = 11) over 12 to 18 months. Medication-symptom scores and adverse events were monitored, serum D farinae–specific IgE and IgG4 levels were measured, and bronchial reactivity to D farinae was determined at baseline and 6-month intervals. Results: Of the 31 randomized subjects, 6 withdrew because of non–treatment-ascribed events. Four withdrew because of treatment-ascribed effects: high-dose group, 1 of 10 (gastrointestinal symptoms); low-dose group, 1 of 10 (gastrointestinal symptoms); and placebo group, 2 of 11 (headache and increased nasal symptoms). Thus 21 subjects completed the study: high-dose group, 9; low-dose group, 7; and placebo group, 5. Eleven of the 21 subjects experienced mild-to-moderate gastrointestinal symptoms, throat irritation, or both (high-dose group, 5/9; low-dose group, 4/7; and placebo group, 2/5). No severe systemic reactions were noted. No differences in symptom-medication scores were found. High-dose SLIT increased the bronchial threshold to allergen challenge and increased serum D farinae–specific IgG4 levels, whereas low-dose SLIT and placebo had no significant effect. Conclusions: High-dose D farinae SLIT was generally tolerable, increased serum D farinae–specific IgG4 levels, and improved the bronchial threshold to allergen challenge. Larger US trials are warranted. [ABSTRACT FROM AUTHOR]